Phase 1 of government mental health review has revealed a fragmented system, long waiting times, and a majority of young people who do not get the help they need. Pete Henshaw takes a look

Only 25 per cent of children and young people with diagnosable mental health conditions access the support they need, while others have faced waits of up to 18 months.

The worrying situation has been described by independent health regulator the Care Quality Commission (CQC), which is warning of a system that is fragmented and varying in quality.

The findings come from the first phase of the CQC’s government-commissioned review of mental health services. It concludes that too many young people are not getting the mental health support they need because it is too difficult to access services.

Published on Friday (October 27), the report draws on existing research, CQC inspections of mental health services, and interviews with young people in a bid to identify the strengths and weaknesses of the current system.

The report finds that more children and young people are being diagnosed with some types of mental health problems than in the past, with at least one in 10 children being affected.

However, the CQC cites Public Health England research from December 2016 suggesting that just 25 per cent of those with a diagnosable mental health condition access support. It also refers to further evidence of long waiting lists, including one case of a young person waiting 18 months to get support.

The CQC says that when it comes to delivering care and treatment in a timely way, 39 per cent of specialist community child and adolescent mental health services (CAMHS) are judged to “require improvement” with a further two per cent rated “inadequate”.

The report states: “When children, young people, their families and carers first try to access help for a mental health problem, many struggle to get timely and appropriate care.

“Children and young people in vulnerable circumstances, such as children in care and those with a learning disability, can find it particularly hard to access care.”

The report says that families, often struggle to navigate the complicated system of services, and blamed “a lack of joined-up working”. It adds: “The system as a whole is complex and fragmented. Mental health care is planned, funded, commissioned, provided and overseen by many different organisations, that do not always work together in a joined-up way. Poor collaboration and communication between agencies can lead to fragmented care.”

Another barrier to accessing support is a lack of skills and training among frontline professionals in identifying mental health needs.

The report states: “Those who work with children and young people – in schools, GP practices and A&E, for example – do not always have the skills or capacity to identify mental health problems or help children and young people access the right support at the right time. Heavy workloads, difficulty in recruiting and retaining staff, and gaps in knowledge and skills all contribute to a situation where services miss opportunities to support children and young people’s mental health and detect mental health problems.”

The report adds that 70 per cent of secondary schools and 52 per cent of primaries are now providing counselling services, which can be an effective early intervention. Strong links between schools and mental health services are also seen as a feature of good practice, with some schools having link workers trained by CAMHS to manage referrals.

When young people are able to access specialist services, they can often expect to receive good quality care, the report adds, with 59 per cent of specialist community services rated good and nine per cent “outstanding”. However, there is considerable variation in the quality of care between specialist CAMHS services, with safety – protecting young people from abuse and avoidable harm – a “significant area of concern”.

The CQC review was announced by prime minister Theresa May in January, alongside plans for every secondary school to be offered mental health first aid training (see http://bit.ly/2z3f3Cb). Additional funding has also been forthcoming, including £1.25 billion for perinatal and children and young people’s mental health between 2015 and 2020.

Dr Paul Lelliott, CQC deputy chief inspector and lead for mental health, said: “The complexity and fragmentation of the system is an obstacle that must be overcome if this new investment is to result in better services to meet the mental health needs of children and young people.”

The CQC report comes after research from the Children’s Society’s found that 30,000 children are being turned away from mental health services every year, and not receiving any support or treatment whatsoever. Matthew Reed, the charity’s chief executive, said the picture painted by the CQC report was “all-too familiar”.

He added: “Vulnerable children in desperate need of help are facing agonising waits for treatment, in many cases without anyone checking in on them to make sure their condition isn’t deteriorating. Even worse, many children struggling with their mental health do not even make it onto the waiting list.

“The current investment focused on transforming these services for our children comes to an end in 2020 but the government needs to start thinking now about more, long-term investment, beyond 2020, in order to solve some of these intractable problems.”

Claire Murdoch, mental health director for NHS England, said: “NHS England has been explicit about the scale of unmet need, which recent improvements have inevitably only been able to begin to tackle. It’s going to take years of concerted practical effort to solve these service gaps – even with new money – given the time it inescapably takes to train the extra child psychiatrists, therapists and nurses required.”

The findings in CQC’s report will inform the government’s Green Paper on children and young people’s mental health, expected later this year. Phase two of the review, to be published in March, will identify the factors that both help and hinder mental health services.